Archive for the ‘NHS Reform’ Category

OTNews have a brief and dispiriting article this month on page 10, entitled Blogging and social networking. I am grateful that this article was brought to my attention as I prepare for a very popular workshop on Social Media Usage at next week’s COTSS Independent Practice conference next week. I think we can have some fun with this…

The article runs off a litany of reasons why blogging and social networking is bad. To summarise they are

breaches of confidentiality

information leaks

defamation

damage to organisational reputation

information to be used for social engineering and identity theft

viruses and other malware

bandwidth consumption resulting in degrading services and wasting time for other users

intimidation of NHS staff leading to investigations.

The article goes on to state that you can download the full checklist (what, there’s more?!) here.

I am not sure what the motive behind the article was, not least because the College is actually quite active in this field itself. It just pops up in the news pages, even though the guidelines referred to date back to December 2009.

The disappointment in it is that it reads in the most reactionary terms. It comes across as being anti-progress by only listing the woebetides and the why nots.

Where is the debate about how we can manage risk and progress? Where is the discussion on the opportunities that become available?

I thought was going to write about the NHS Confedration’s consultation paper, and looking in particular at the consortia that service purchasers, previously known as GPs, will be obliged to join. I might get onto that later.

Instead I got distracted by a curious search that has come up on the blog stats. It read;

“Challenge what I think”

Someone had searched for “Challenge what I think” and Google, in its infinite algorithmic wisdom sent them here.

That set in motion a chain of thought. How readily do we open ourselves to being challenged in what we think?

The two topics are not entirely disconnected. The angle I was contemplating on NHS reform was that it is easy to get stuck in resistance, anger and opposition. We might rail against the system on the basis that it is

Wasteful

A broken promise

Unnecessary

Politically motivated

Unworkable

Meddling

Unwelcome change

or we can recognise that the march of this reform is inevitable. Once we do that then the challenge is not to change the system or the political tide, but to look to ourselves and change how we are going to respond to it and engage with that change.

Note the word “Respond” as opposed to “React”

For those who are employed within the NHS, then we need to consider our roles within our teams. How can we bring greater value, not just in pounds and pence, but in contribution? What skills can we tap into to make our contributions more meaningful?

This has motivated the previous posts about self-effectiveness, or self leadership. How can we position ourselves as being central to a team’s effectiveness, but not in a destructive way that undermines others, but constructively, helping to support and improve the whole.

For independent practitioners, how are you going to position yourselves in order to market your services to a larger number of smaller purchasers? What do you need to do to demonstrate utility, effectiveness and ensure (to use the current buzzword) improved outcomes.

The current uncertainty needs us to remain adaptable. It might mean getting to grips with social media – and the momentum that is now seen within social media and occupational therapy is very exciting.

It might mean, depending on how the consultation goes, that we need to be much more commercial in selling ourselves.

For some, let’s be realistic, it might mean looking for new roles altogether.

All of this needs us to be open to be challenged about the way we think.

We need to break the well worn patterns of X leads to Y and therefore Z applies. Experience shapes our responses so that if we find ourselves facing a situation we anticipate the outcome will the same as last time. That can often drive how we respond.

And yet the outcome, to some extent, is shaped by our intervening response. What if we choose, therefore, a different response?

What options have we got to select from?

What responses have we not tried previously and how might they serve us, and our service users and clients, better?

What new responses can we create for ourselves?

For more on this consider the issue of heuristics – there is a good summary on Wikipedia, right here.

Two issues stand out as they may relate to occupational therapists upon our brief initial reading, namely

The Government will devolve power and responsibility for commissioning services to the healthcare professionals closest to patients: GPs and their practice teams working in consortia

To strengthen democratic legitimacy at local level, local authorities will promote the joining up of local NHS services, social care and health improvement.

How do you think occupational therapists will we be employed, or if we work independently, to whom are we offering our services, and how will we do that?

Will it be the various GP consortia? How will they be run? Will they be self governing, as a local collective, or will they be administered by external, out-sourced services from the privte sector?

How will we be required to work between local authorities and these new consortia?

And what of this passage, for those who work with adults?

We want a sustainable adult social care system that gives people support and freedom to lead the life they choose, with dignity. We recognise the critical interdependence between the NHS and the adult social care system in securing better outcomes for people, including carers. We will seek to break down barriers between health and social care funding to encourage preventative action.

With the imminent election, and even more imminent budget, the future funding of the NHS, and possible NHS spending cuts is a real hot topic.

In my previous post I highlighted the NHS Confederation’s report on Rising to the Challenge.

I have just been recapping their fascinating series on leadership from Spring 2009.

The fact that there are going to be massive cuts and the need for efficiency drives within the NHS is a given. It is going to be unavoidable, as it will be in any other public sector. What is not clear is how the system, and the individuals within it, will respond to those changes.

It is a time for leadership to come to the fore on a corporate and individual basis.

Leadership needs to be inside out, not back to front.

What is back to front leadership?

Back to front leadership is reactionary knee jerkism. Back to front leadership only looks ahead at what is to come and reacts to it.

It is like reading the last page of a novel and guessing what might happen in the other 250 pages for yourself to fit with the conclusion you have just seen.

It is reactionary and often misguided. The steps that are taken might match the predicted outcome (reduced costs) but may make no sense along the way.

Inside out leadership is different.

It still sees what the big picture is – there is no self deception or self comforting delusion here. However it then works from the inside outwards to ensure that the necessary re-organisation fits the outcome and is consistent and coherent throughout the organisation.

This is much more challenging. It requires the ability of managers and leaders (very different roles by the way) to be able to communicate, reassure, be honest and yet still move the team forward. It takes courage to make those unattractive decisions. There is no room here for procrastination or avoiding tough decisions and the subsequent conflict that will arise.

These leadership traits are not simply required in those we follow or look to for guidance and decision-making. We can all develop leadership qualities ourselves and, as we do so, then we strengthen our own positions within our teams, employment but also within our personal lives and decision making.

Personal leadership also needs to be inside out, not back to front.

As we challenge ourselves to face up to several years of turmoil within the NHS , we have a choice.

We can read the writing on the wall and despair. Maybe some will just give up, or others will keep a low profile hoping not to be noticed in any cutbacks. That is the back to front approach.

The inside out approach to self leadership will be to look at ourselves.

What is it that we do really well?

Where can we improve?

What value and importance do we offer to our clients?

What value and importance do we derive for ourselves from what we do?

What is it that really fires us up?

Where do you want to be in say 3 to 5 years time, rather than where do you think the system will leave you in 5 years time?

These are all internal questions but they will have a profound impact and shape your external presentation.

If you are sure of why you do what you do, and if you have a vision for your career which is rooted to your values then you will be seen as someone to be kept hold of, and even promoted as and when opportunities continue to arise.

People will see you as bold, courageous. You will be called inspirational. People will turn to you for your opinion and guidance.

You become sought after and increasingly central to your team or organisation.

You will not avoid the tough times ahead but will be better positioned to roll with them, take the blows and carry on forward instead of falling into despair. This resilience will, again, position you as a natural leader within your organisation as a result of developing your internal self leadership characteristics.

Here at Harrison Training we are continuing to expand our leadership skills training program for occupational therapists and other health care workers at all levels of seniority. Let us know if this is something that you would like to bring into your organisation, or access personally, to help you and your people rise to the challenges that are to come.

The NHS Confederation is the voice for NHS leadership. Their report is a call to the vying political parties about how they should approach NHS policy after the imminent election.

The whole report is only 20 pages. The report offers some reassurance that the right noises are being made by the professions leaders. Of course, whether they are heard or not remains to be seen.

Consider, though, this excerpt;

“Patients and groups of patients need more support to manage their own conditions. National policy can help by commissioning training and education, evaluation of programs and research to support new approaches. however most of this has to be local and may be organised by patients or social enterprises. It could include:

telecare and homecare services

faster procurement of aids and home adaptations

more responsive rehabilitation services that are more accessible to both patients and professionals” page 12 Rising to the Challenge

With all of that in mind, it seems clear to us, that this call, together with Gordon Brown’s call for greater reablement service provision could place occupational therapy at the very front of health care reform in the near future.

One of my favourites is the Salford University OT Educational blog. The blog works becasue it expands diverse thoughts into debates. A great example is this article on a recent leadership event the University hosted.

“occupational therapists need to be encouraged to lead but that they should have greater awareness of the types of challenge they face in the NHS and Social Care so that they lead consciously and effectively overcoming professional and gender discrimination.”

The discussion, and debate grows within the comments attached to that blog and please do go and read them and contribute.

The challenge that is presented is trying to understand just what leadership means in an OT context? What elements of leadership, if any, are relevant to NHS and Social Care in particular?

Indeed, what are we talking about when we talk about leadership?

Leadership is not something that only those in charge require. We all display elements of leadership characteristics in various aspects of our life – it would seem very difficult to have a successful therapeutic relationship without having a degree of leadership. How can we, as a profession, further identify and refine those skills to benefit our clients, employers and also enable us to work in ways which are truer to ourselves?

There is an important role for occupational therapists in providing more reablement and rehabilitative services to local authorities, to ensure that clients do not find themselves marooned in hospital wards and longer term residential care.

A key part of this was to provide extend reablement or rehabilitative support …

“…to help with the transition back home after a hospital stay, a residential care stay, or simply a fall or accident…” Source

The immediate political storm revolved around funding and the view held by many that this was cynical political grandstanding. Regardless of the politics, reablement at home will be appropriate in many situations.

It has to be unattractive that an admission to hospital for a minor issue results in a client not being discharged just because of a lack of rehabilitative care. To appease the political wing, this is also likely to be uneconomical.

Some of the immediate criticism of the Personal Care at Home Bill was wide of the mark. This letter in The Times, for example, states that

“Two, three, or even four hours of care a day does not help someone living with a neurodegenerative disease, who is immobile and has other serious health needs. Only 24/7 care can provide this.” Source

That is, I believe, an extreme position and therefore a false argument to set up. It does not disprove a role for reabling work. It simply states the obvious that it would not be adequate for that particular client.

The feverish political baying that surrounds any health care announcement in the run up to an election should not drown out the substantive debate.

How can the occupational therapy sector facilitate reablement, for example after a hospital visit, using the skills they already have in rehabilitation, adaptive technology, seating, gait and the like?